HomeMy WebLinkAbout0844 O~alarallon ot Doml~11• a~d Cltlt~n~~p ~
TO TNE STATE ANQ COUNTY TAX ASSE550R, ~rQ~~~
51. lUC1E COUNIY, FIORIDA:
This is my detla~ation of Oomicile a~d Citizenship in the St~te of Florida that 1 ~m tilin9 thit day in aoco~dancs end
in conformity with Chapte~ 222, Section 224.17. Florid~ StatuMs.
1 was fo~merly ~ le9ai resid~nt of ~ 1 ~
(City . (Stah)
snd 1 rosiclsd at " . How~vK I hav~ tharp~d my domid~
~t a~d Numbs~)
ro and am and haw been e bo~a fid~ resident of the Stats of Fiorida sFno~ ~~day of
. 19~nd 1 resid~ at ~
(Stn~t and Number)
I~ORT M~, SAINT IUGE COUNTY, RORIDA
and this statement is to be taken as my detlaration of citiz~nship, actual le~al r~sidente a~ domidle in th~ State of Fiorida.
(Insert here any psrtinent facts, such as sale of prop~rty or bu:in~u, or relinquishme~t of employmsnt
at formar domkile, ~emoval of family to new domicile, purchase of hom~, ~tc.)
. ~
~ s~ 4.b 1 i sti. ed ~~;e.t,~ e. ~ ,
~~L~O AMD RE
CIE Qp
GCER P01~
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I RJRTHER ~fRTIFY that 1 wiil oomply with all other r~quir~menb of a le~al residsnt of this State.
I FURTHER CERTIFY that I have no intention to ~etum to my former domidle, and 1 inte~sd b remain in FORT
PIERCE, SAINT WCIE COUNTY, FLORIDA, permanently.
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Sworn to ~ctid,wbtuibad before me this ~..f~ day of , 19~
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c~ : ~ . - Notary Public
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f~ ~ .C. My Commiuion expires
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a~ 192 842
tdo. 13
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